Ms MACKLIN(3.39 p.m.) —When Labor came to power in 1983, older Australians could have been described as the forgotten generation. Over the next 13 years, successive Labor governments set about addressing the situation of the elderly in our community. Our aim in government was to build up a holistic system of support for the aged—one that covered transport, housing, respite care, services to the elderly in rural areas and the elderly in minority groups. Successive Labor governments in the 1980s recognised the problem and systematically set about implementing a long-term program of improving the situation of the aged in our community.

As those opposite will now know, the program became formally known as the aged care reform strategy. I am very proud that my predecessor, the previous member for Jagajaga, had very a large hand in implementing these reforms. The strategy had a number of aims: to change the balance of care away from nursing home care to support for people living in their own homes or in hostels; to develop a greater range of care choices for the frail aged; to improve standards of care in nursing homes as a result of the introduction of an upgraded program of monitoring; and to ensure that no pensioner in a nursing home would be required to pay more than 87.5 per cent of the standard pension.

It is significant then that the minister responsible for aged care in this government, the Minister for Family Services (Mrs Moylan), is prepared to canvass older people paying more for nursing home or hostel care. On the Four Corners program recently she also refused to rule out a death tax for older people to pay their nursing home bills. How does this possibly sit with the commitment to no new taxes? Does it mean no new taxes, except on the most vulnerable in our community—elderly people in nursing homes?

Labor's strategy also emphasised the provision of higher benefits in hostel funding for those with higher care needs, support for carers and an action plan for dementia. Labor's commitment in this area is dramatically illustrated by our willingness to find the money to set about improving the position of older Australians. For example, in the area of home and community care, Labor's expenditure grew from $152 million in 1984-85 to $613 million in the last year or so. This represents a 163 per cent increase in real terms. That is the sort of need that Labor was left with to fill in 1983.

It is fortunate for this government that the increases are there in the forward estimates to meet the growing needs of older Australians and their reasonable desire to remain independent in their own homes for as long as possible. But yesterday the Minister for Family Services refused to commit herself to this growth for home and community care, even though it is explicitly written in the coalition's election policy.

It needs to be acknowledged that when Labor came to power the Commonwealth was spending $0.8 billion on nursing homes. Under Labor this grew to $1.8 billion. In fact, under Labor, aged spending in total grew to $2.9 billion in 1995. In real terms that represents a 62 per cent increase, compared with an estimated increase of only 33 per cent in the target population over the same period.

In its pre-election promises, the government made many commitments to the people of Australia. Their promises were taken on trust. These promises, especially those to the elderly in our community, received further ratification by the Prime Minister (Mr Howard) when he said:

Now, one group in the community that is not going to be hurt is the most vulnerable. . . . we will protect the vulnerable and the needy.

These sentiments deserve the total support of this parliament. It would be carrying forward the work done in the area of aged care by previous Labor governments—governments that were guided by the basic principle that the way we respect and care for our aged and vulnerable is one of the yardsticks that measures how civilised, how decent, our community is.

Unfortunately, this government is not in power for more than five minutes when it seems to be trying to duck away from these promises. Could it be that these fine promises were nothing more than electioneering rhetoric, aimed at conning the Australian public into believing that a Howard government really did care for people? If so, how do we explain the implications of the proposals gradually revealed by the Minister for Health and Family Services (Dr Wooldridge) over the last week? Even the manner of their public presentation has been a revelation. There was not a straightforward statement of intent, rather a succession of media releases, radio interviews and doorstops that gradually revealed this government's grand strategy: handing the bulk of aged and community care services back to the states.

This plan is presented as a masterstroke, a means of cutting out duplication and waste. But is it simply a means of helping finance what has come to be known as a `Costello con'? In fact, this is simply a trick to make the states responsible for a very difficult and costly area of government. We can only hope that even Liberal state governments will not be part of it.

This area, I would suggest, is a true test of a government's commitment to its people—and this government fails that test at the first opportunity. What does handing these services back to the states mean? To understand the full implications of this, we need to appreciate the situation that existed before Labor governments began to take an increased responsibility for financing and regulating care for the aged.

The Giles report in 1984 makes a good starting point. I will not show you the pictures because I find them too gruesome myself. It paints a very graphic picture of the types of problems that used to occur under state supervision and which could easily occur again. There were great variations in the quality of care provided, in staff to resident ratios, and too much of the care itself was of an unacceptably low level. In fact, the Giles report talks of 20 nursing homes in the Melbourne area alone that were guilty of `inhumane conditions and treatment'.

Melbourne was not alone in this. The Giles report says that substandard nursing homes were prevalent in every state. Failure to guarantee minimum national standards is a fundamental failure for a national government. It is not just we in the opposition that see these hand-back proposals—the son or daughter of Fightback—as an outrageous abdication of responsibility.

Aged care providers, representing both community and commercial interests, have been very swift to register their disapproval and dismay at this prospect. The Australian Catholic Health Care Association, representing 200 nursing homes and 55 hospitals, said in a media release on 3 May this year said:

Why would the minister want to transfer a national program from one jurisdiction to eight? It makes no sense.

The Australian Nursing Homes and Extended Care Association, representing private enterprise and church, charity and community operators of residential care facilities, issued a media release on 2 May which was headed `Aged Care Providers Reject Transfer to States'. The association said they would `reject outright any plans by the federal Minister for Health and Family Services to transfer to the states responsibility for financial allocations and standards monitoring in aged care programs'. They went on to say:

Care of the frail aged in our community requires a national approach to ensure adequate funding . . . and the consistent delivery of quality care across the whole of Australia.

This task will be even more difficult to achieve if six state and two territory governments are involved.

Alarmingly, they further go on to say:

Neither the Minister for Health and Family Services nor any representative of the Federal Government has discussed this proposal with aged care service providers.

Dr Lawrence —That is consultation for you.

Ms MACKLIN —That's it. What are we getting to here? Is this going to be government by decree, free from any consultation with interest groups? One has to wonder where the minister went for his information and what sorts of efficiencies he really has in mind. Would he call it efficient to return to the pre-Giles report scenario where it was all too common for large variations to occur in the availability of residential care and large variations to occur in the quality of care?

The minister's proposals have provoked further criticism. Reverend Ray Cleary, Chief Executive Officer of the Melbourne City Mission, in opposing the transfer of aged care services to the states, says:

This pass the parcel game seems to be the force determining the question of responsibility for aged services. The focus ought to be on the client.

He asks:

What better outputs can be achieved by devolution?

Reverend Cleary then goes on to say:

The loser in this game will always be the increasing percentage of elderly citizens of Australia who require specialist aged care services.

He also points out that the general perception among aged care providers is that when the states were responsible for standards of care the monitoring was inadequate.

What was the response of the Minister for Health and Family Services to this criticism? On 2 May, he conceded that his plan may see differing health standards across the country. In his view—I cannot imagine what this means as far as aged care goes—this will encourage `competitive federalism'.

Dr Lawrence —That means you can move from South Australia to Victoria.

Ms MACKLIN —That's right. I think the minister might have difficulty pointing out the advantages of competitive federalism to elderly people forced into substandard care as a result of his washing his hands of this responsibility.

The loss of federally regulated outcome standards is just the beginning of the problem. It is one thing to hand over responsibility to the states and receive undertakings from them in return. It is quite another to guarantee that the states will actually live up to these undertakings. In fact, establishing and maintaining adequate levels of accountability or performance from the states has been shown in other areas of government to be almost impossible.

There can be no guarantee that the states will spend the money the Commonwealth allocates with these sorts of agreements. The minister, in one of his statements, says that he would tell the states, `This is what we expect in the way of outcomes; you go and meet them.' Even assuming that all the states would accept this interesting direction in good faith and with goodwill—a huge assumption given the problems we have had with Medicare agreements—the minister is grossly oversimplifying an incredibly difficult and complex task.

The crucial factors which are very difficult to measure in these areas, if they are not carried out properly, are quality of nursing home care, development of independent living skills and sensitive care of those suffering from dementia. These will be ignored if they are not able to be properly monitored nationally. When you find that the states have not spent the money you have allocated for aged care, what will you do? You will be able to do nothing, and elderly people will be left without any care.

This process is likely to be exacerbated by certain concomitant moves to introduce market principles into community services and aged care—things such as compulsory competitive tendering, privatisation and user-pays. We have seen a lot of it in Victoria. The latest idea in Victoria is to tender out Meals on Wheels. That is where you are transferring aged care to—to people who have that sort of attitude to aged care.

The people of Australia are going to want to know where in your policies before the election did you reveal the plan for such a revolutionary change in health and community services. In fact, like other conservative governments before you, particularly ours in Victoria, having been elected on one agenda, the real agenda remains hidden.